Provider Engagement Account Manager – State

Role Overview

• Maintain partnerships between the health plan and contracted provider networks.
• Build client relations to ensure delivery of care to members.
• Engage with providers on network performance opportunities and solutions.
• Drive optimal performance in contract incentive performance, quality, and cost utilization.
• Serve as primary contact for providers and liaison between providers and health plan.
• Triage provider issues as needed for resolution to internal partners.
• Receive and respond to external provider related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Educate providers regarding policies and procedures related to referrals and claims submission.
• Perform provider orientations and ongoing provider education.

Requirements

• Bachelor’s degree in related field or equivalent experience.
• Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience at a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible work with remote, hybrid, field or office work schedules